Hyperglycemic Crisis in Adults: Pathophysiology, Editor’s note: This article is the 9th in a 12-part series reviewing the funda- mentals of diabetes care for physicians in training. Previous articles in the series can be viewed at the Clinical Diabetes website (http://clinical. water and the flow is incessant . . . . Life is short, unpleasant and painful, thirst unquen
Need to realign patient-oriented and commercial and academic researchCorrespondence
the Responsibility Deal—eg, the need amides in young children. However, Winfred Wang and colleagues1 report for robust, independent, transparent the conclusion that these agents that hydroxycarbamide therapy can scrutiny of commitments made and can now be used in all children now be considered for all very young the beneﬁ ts of a local approach.
with sickle-cell anaemia might be children with sickle-cell anaemia, Public health sits within a wider premature, since there are still several socioeconomic system. The project unanswered questions.
First, given the current knowledge is a substantial concern in patients by a public health team in the region about disease phenotypes, it is not who receive long-term hydroxy-that was prepared to take a risk with clear that the sample size in this carbamide.2 Complications and clinical an unproven concept.4 Critics need to study captured a fair representation eﬃ cient evidence that of severe disease phenotypes. Thus and colleagues’ trial, some patients an intervention is meeting planned whether the safety proﬁ le of this were asymptom atic, and the severity outcomes because of short follow-up drug will justify its use in all or a of the underlying disease varied times does not equal evidence that such select group of young infants with widely between patients. Whether initiatives do not work. The scepticism sickle-cell anaemia remains an open early initiation of hydroxycarbamide with which projects of this nature have is beneﬁ cial in asymptomatic patients Second, and perhaps more as well as those with severe sickle-cell on preformed conclusions rather than important, is the need to address anaemia remains unknown.
objective evidence. A reconsideration the potential use of this drug where We declare that we have no conﬂ icts of interest.
of this stance is in order.
it is likely to have the most eﬀ ect on *Yukie Takahashi, Jinichi Mori, The project to which this letter refers was funded by global health—ie, settings with a high Masaharu Tsubokura, the Department of Health East Midlands. We declare that we have no conﬂ icts of interest.
poor health-care infrastructure. What firstname.lastname@example.org
is the potential eﬀ ect of long-term Tokyo Metropolitan Cancer and Infectious Disease neutropenia and hyposplenism on Center, Komagome Hospital, 113-8677 Tokyo, Japan email@example.com
the outcome of patients in settings (YT, JM); and Division of Exploratory Research, Clinical Sciences Building, Division of Epidemiology where malaria is endemic and Institute of Medical Science, University of Tokyo, and Public Health, University of Nottingham, invasive bacterial infections are highly Nottingham City Hospital, Nottingham NG5 1PB, UK (RP, PM, PS); and Department of Health, East Hydroxycarbamide in very young children with Midlands, Directorate of Health and Social Care East sickle cell anaemia: a multicentre, randomised, controlled trial (BABY HUG). Lancet 2011;
safe blood transfusion cannot be 2 Schultz WH, Ware RE. Malignancy in patients leadership in England? Lancet 2011; with sickle cell disease. Am J Hematol 2003; 378: 1060.
Department of Health. Public Health Responsibility Deal. http://www.dh.gov.uk/en/ Publichealth/Publichealthresponsibilitydeal/ Emphas!s. East Midlands Platform on Obesity, Need to realign
Physical Activity and Health. http://www.
Wanless D. Securing good health for the whole ernments in the sub-Saharan region commercial and
population: ﬁ nal report—February 2004. http:// www.dh.gov.uk/en/Publicationsandstatistics/ academic research
Publications/PublicationsPolicyAndGuidance/ We declare that we have no conﬂ icts of interest.
Clinical research is motivated by several factors. Some are more defensible than Hydroxycarbamide use
in young children with
Michigan State University, East Lansing, MI 48824, sickle-cell anaemia
USA (SKO); Guy’s and St Thomas NHS Foundation Trust, London, UK (BI); and Barts and the London School of Medicine and Dentistry, London, UK (PT) studied,1,2 but these are exceptions.
Hydroxycarbamide in very young children with sickle-cell anaemia: a multicentre, randomised, controlled trial (BABY HUG). Lancet 2011; 377: 1663–71.
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what clinical researchers do and what companies and with input from patients need. I am a researcher; I have Department of Error
Usher AD. Donors continue to hold back support for research; and I have had multiple new governance strategy would be from the Global Fund. Lancet 2011; myeloma for the past decade. A few to bring together all the stakeholders, 378: 471–72—In this World Report (Aug 6),
the ﬁ rst line of the seventh paragraph should
years ago I stated publicly that several have read “Germany, the Global Fund’s fourth uncertainties I faced at the beginning and ongoing research, produced in- largest donor after the USA, France, and the UK, immediately froze its disbursement of $285 million that had been allocated for 10 years later—after a relapse of my Patient advocacy groups in myeloma 2011”. The correction has been made to the ology” of myeloma studies on hoping to promote better care. With The Lancet. China’s major health challenge: control ClinicalTrials.gov. On July 31, 2011, public support they should be in a of chronic diseases. Lancet 2011; 378: 457—In
a search using the term “multiple strong position to call for a redeﬁ nition this Editorial (Aug 6), the ﬁ rst sentence of the myeloma” identiﬁ ed 1384 studies. Of of the research agenda, in the interests
second paragraph should have read “A headline statistic in the report is that reduction of mortality from cardiovascular disease by only tive studies. However, in only 58 of be further debated in The Lancet for 1% per year between 2010 and 2040 will save these studies was overall survival an many other areas of clinical research in the country a staggering US$10·7 trillion.” This correction has been made to the online version I thank Mariangela Taricco, Iain Chalmers, head-to-head comparison of diﬀ erent Gianni Ciccone, Michele Cavo, Nicola Magrini, and Mandell DS, Levy SE, Schultz RT. Eﬀ ectiveness of drugs or strategies. Meanwhile, Roberto Satolli for useful comments in preparation of intensive autism programmes—Authors’ reply. this letter. I declare that I have no conﬂ icts of interest.
Lancet 2010; 375: 723—In this
Correspondence (Feb 27, 2010), the second and gene-expression proﬁ ling will lead Alessandro Liberati paragraph should have read: “With regard to firstname.lastname@example.org
other randomised trials of ABA, space limitations prevented a more thorough oma,4 and pharmaceutical companies Università di Modena and Reggio Emilia, Modena, listing of references within that review; avoid research that might show that Italy; and Agenzia Sanitaria e Sociale Regionale, Vismara’s article is Rogers’s 1998 review3 of Buckley BS, Grant A, Glazener CMA. Case study: ﬁ ve studies preceding the ﬁ ve referenced in a patient-clinician collaboration that identiﬁ ed her 2008 article. We originally classiﬁ ed these and prioritized evidence gaps and stimulated as randomised trials, but accept that they in research involvement. J Clin Epidemiol 2011; published online Aug 3. DOI:10.1016/j.
correction has been made to the online version Stewart RJ, Caird J, Oliver K, Oliver S. Patients’ and clinicians’ research priorities. Health Expect Malfertheiner P, Bazzoli F, Delchier JC, et al. DOI:10.1111/j.1369-7625.2010.00648.x.
Helicobacter pylori eradication with a capsule Liberati A. An unﬁ nished trip through the
uncertainties. BMJ 2004; 328: 531–32.
containing bismuth subcitrate potassium, metronidazole, and tetracycline given with Russel SJ, Rajkumar SV. Multiple myeloma and the road for personalised medicine. omeprazole versus clarithromycin-based triple Lancet Oncol 2011; 12: 617–19.
therapy: a randomised, open-label, and academic—which lead them to 5 Liberati A, Moja PL, Trotta F, Traversa G. non-inferiority, phase 3 trial. Lancet 2011; Feasibility and challenge of independent 377: 905–13—In this Article (March 12), the
research on drugs: the Italian Medicines fourth sentence of the third paragraph in the Agency (AIFA) experience. Eur J Clin Invest Procedures section (p 906) should have read: 2010; 40: 69–86.
“In the 7-day standard regimen, one capsule of omeprazole, two of amoxicillin, and one of clarithromycin were taken twice daily (before morning and evening meals).” This correction has been made to the online version as of Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 2011; 378: 815–25—In this Series paper (Aug 27),
the x-axes of parts A–D of ﬁ gure 5 were
labelled incorrectly. The label should have been x100 000, and the values should have been diﬀ erent for the USA (10, 20, 30) and the UK (2, 4, 6). These corrections have been made to the online version as of Nov 18, 2011.
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SAFETY DATA SHEET PYNOSECT POWDER 1. IDENTIFICATION OF THE SUBSTANCE AND OF THE COMPANY Identification of substance: Pynosect Powder Company Identification: Mitchell Cotts Chemicals, P O Box 6, Steanard Lane, Mirfield, West Yorkshire, England, WF14 8QB Tel: +44 (0)1924 493861 (24 hours) 2. COMPOSITION/INFORMATION ON INGREDIENTS Chemical Composition: Contains 5 g/kg